Exposure keratopathy (EK) has a high incidence in critically ill patients. We aimed to determine the rate of EK in patients admitted to our intensive care unit (ICU), identify risk factors for developing EK and ascertain the effectiveness of a protocol to prevent EK.
We undertook a two-phase prospective cohort single-centre study in a general adult ICU. The first phase of the study was observational. In the second phase of the study an eye care protocol was introduced. Daily ophthalmic assessment was carried out using a portable slit lamp. We also recorded Acute Physiology and Chronic Health Evaluation II score, daily Sequential Organ Failure Assessment score, mechanical ventilation, Richmond Agitation-Sedation Scale, and level of eye care. Student’s t test and χ 2 statistics were used for simple analysis of continuous data and categorical data, respectively. Binary logistic regression was used to analyse the relationship between EK (yes/no), as the dependent variable, and multiple independent variables, calculating unadjusted and adjusted odds ratios.
We studied 371 patients. In the first phase, the overall rate of EK was 21% but the rate in mechanically ventilated patients was 56%; χ 2 (1, N = 257) = 80.8, p < 0.001. Adjusted odds ratios (AOR) for development of EK were 28.6 (8.19–43.37), 13.0 (3.16–54.38) and 1.2 (1.03–1.33) with incomplete eye closure, mechanical ventilation, and higher SOFA score, respectively. Following the introduction of the protocol in the second phase, the overall rate of EK reduced to 2.6% (three cases); χ 2 (1, N = 371) = 18.6, p < 0.001. Compliance with the protocol was 97%.
EK is common in critically ill patients, and is associated with mechanical ventilation and incomplete eye closure. A simple protocol substantially reduces the incidence of EK and is easily achieved in clinical practice.
American Academy of Ophthalmology. Basic and clinical science course: section 8: external disease and cornea. Singapore: American Academy of Ophthalmology; 2011. p. 80.
Imanaka H, Taenaka N, Nakamura J, Aoyama K, Hosotani H. Ocular surface disorders in the critically ill. Anesth Analg. 1997;85:343–6. PubMed
Masoudi AN, Sharifitabar Z, Shaeri M, Adib HM. An audit of eye dryness and corneal abrasion in ICU patients in Iran. Nurs Crit Care. 2014;19:73–7. CrossRef
Saritas TB, Bozkurt B, Simsek B, Cakmak Z, Ozdemir M, Yosunkaya A. Ocular surface disorders in intensive care unit patients. Sci World J. 2013;2013:182038. CrossRef
Hernandez EV, Mannis MJ. Superficial keratopathy in intensive care unit patients. Am J Ophthalmol. 1997;2:212–6. CrossRef
Koroloff N, Boots R, Lipman J, Thomas P, Rickard C, Coyer F. A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient. Intensive Care Med. 2004;30:1122–6. CrossRefPubMed
Kalhori RP, Ehsani S, Daneshgar F, Ashtarian H, Rezaei M. Different nursing care methods for prevention of keratopathy among intensive care unit patients. Glob J Health Sci. 2015;8:53131. CrossRef
Sivasankar S, Jasper S, Simon S, Jacob P, John G, Raju R. Eye care in ICU. Indian J Crit Care Med. 2006;10:11–4. CrossRef
- Incidence, risk factors and impact of protocolised care on exposure keratopathy in critically ill adults: a two-phase prospective cohort study
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
e.Med Kampagnen-Visual, Mail Icon II